SSA listing 11.09: multiple sclerosis (and 11.06 Parkinsonian syndrome).

The short version

Listings 11.09 (multiple sclerosis) and 11.06 (Parkinsonian syndrome) are worded almost identically: each is met by paragraph A or paragraph B. A is disorganization of motor function in two extremities causing extreme limitation in standing up, balancing or using the upper extremities. B is marked limitation in physical functioning plus marked limitation in one of four areas of mental functioning. The one textual difference is that 11.06 adds "despite adherence to prescribed treatment for at least 3 consecutive months."

TNAADO covers the two on one page because the criteria are the same text; building two pages from identical wording would only repeat it.

The two listings as printed

Paragraph A: disorganization of motor function

Section 11.00D1 defines the term: "Disorganization of motor function means interference, due to your neurological disorder, with movement of two extremities; i.e., the lower extremities, or upper extremities (including fingers, wrists, hands, arms, and shoulders). By two extremities we mean both lower extremities, or both upper extremities, or one upper extremity and one lower extremity."

Paragraph A then requires that this interference result in "an extreme limitation" in at least one of three abilities. Section 11.00D2 defines extreme limitation as "the inability to stand up from a seated position, maintain balance in a standing position and while walking, or use your upper extremities to independently initiate, sustain, and complete work-related activities."

• Inability to stand up from a seated position "means that once seated you are unable to stand and maintain an upright position without the assistance of another person or the use of an assistive device, such as a walker, two crutches, or two canes."
• Inability to maintain balance "means that you are unable to maintain an upright position while standing or walking without the assistance of another person or an assistive device, such as a walker, two crutches, or two canes."
• Inability to use your upper extremities "means that you have a loss of function of both upper extremities (including fingers, wrists, hands, arms, and shoulders) that very seriously limits your ability to independently initiate, sustain, and complete work-related activities involving fine and gross motor movements."

The word "or" between the three abilities means one is enough for paragraph A, and the printed examples show how high the bar is set: the definitions are about needing another person or an assistive device such as a walker, two crutches or two canes, not about slowness or difficulty.

Paragraph B: marked physical limitation plus one mental area

Paragraph B is the combined test. Section 11.00G1 says the disorder "must result in a marked limitation in physical functioning and a marked limitation in at least one of four areas of mental functioning." It also routes people with mental limitations but without marked physical limitation elsewhere: if the disorder produces extreme limitation in one mental area, or marked limitation in two, "but you do not have at least a marked limitation in your physical functioning, we will consider whether your condition meets or medically equals one of the mental disorders body system listings, 12.00."

"Marked" is defined in 11.00G2 as "the fourth point on a five-point scale consisting of no limitation, mild limitation, moderate limitation, marked limitation, and extreme limitation," and the text adds "The term 'marked' does not require that you must be confined to bed, hospitalized, or in a nursing home." For physical functioning it means being "seriously limited in the ability to independently initiate, sustain, and complete work-related physical activities" and the regulation says SSA does not define it "by a specific number of different physical activities or tasks" but by overall effects "on a consistent and sustained basis." A person "need not be totally precluded from performing a function or activity to have a marked limitation."

What multiple sclerosis adds: 11.00N and fatigue

Section 11.00N2 says SSA evaluates signs and symptoms "such as flaccidity, spasticity, spasms, incoordination, imbalance, tremor, physical fatigue, muscle weakness, dizziness, tingling, and numbness" when deciding ability to stand up, balance, walk, or perform fine and gross motor movements, and also considers secondary problems "such as fatigue; visual loss; trouble sleeping; impaired attention, concentration, memory, or judgment; mood swings; and depression." A vision impairment from MS may be evaluated under the special senses body system (2.00).

Section 11.00T adds that fatigue "is one of the most common and limiting symptoms of some neurological disorders, such as multiple sclerosis," that it may be physical or mental, and that SSA considers "the intensity, persistence, and effects of fatigue on your functioning," feeding it into both the paragraph A motor test (11.00D) and the paragraph B functional test (11.00G).

What Parkinsonian syndrome adds: 11.00K and the three-month rule

Section 11.00C is what the extra words in 11.06 refer to. It says that in 11.02 (epilepsy), 11.06 (Parkinsonian syndrome) and 11.12 (myasthenia gravis) SSA requires "that limitations from these neurological disorders exist despite adherence to prescribed treatment." It defines that as having "taken medication(s) or followed other treatment procedures for your neurological disorder(s) as prescribed by a physician for three consecutive months but your impairment continues to meet the other listing requirements despite this treatment." It also says you may receive treatment "at a health care facility that you visit regularly, even if you do not see the same physician on each visit." Listing 11.09 for multiple sclerosis has no such sentence in its text.

Where cognitive or mood problems fit

Section 11.00A says that when a neurological disorder causes mental limitations, such as Huntington's disease or early-onset Alzheimer's disease, SSA evaluates them with the functional criteria in 11.00G. But "if your neurological disorder results in only mental impairment or if you have a co-occurring mental condition that is not caused by your neurological disorder (for example, dementia), we will evaluate your mental impairment under the mental disorders body system, 12.00."

That handoff is the same one described on the neurocognitive page for listing 12.02, which names MS and Parkinsonian syndrome among the conditions that can cause dementia. The two body systems are meant to be read together; which fits depends on how the limitations divide between physical and mental functioning.

What this page does not do

It does not say whether you meet listing 11.09 or 11.06, diagnose, or advise on a claim. Neurological conditions that fall short of these listings are still considered in the wider disability process. The regulation changes over time; check the linked eCFR page for the current text.